Diphtheria

Aka: Diphtheria, Pseudomembranous Pharyngitis, Corynebacterium diphtheriae

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II. Epidemiology

  1. Rare in United States due to Immunization (DTP, DTaP)
    1. However 20% of adults may be inadequate Immune Status
  2. Ongoing epidemic in the former USSR

III. Pathophysiology

  1. Causative Organisms
    1. Corynebacterium diphtheriae
    2. Other Corynebacterium species (ulcerans, pseudotuberculosis) may be rarely transmitted from animals to humans
  2. Diphtheria Toxin
    1. B-Binding Subunit
      1. Binds heart cells and Neurons
    2. A-Action Subunit
      1. Elongation factor (EF2) ribosylated by ADP
      2. Inhibits mRNA translation into Proteins

IV. Symptoms

  1. Sore Throat
  2. Dysphagia
  3. Weakness
  4. Malaise

V. Signs

  1. Toxic appearance
  2. Low grade fever
  3. Tachycardia (out of proportion to fever)
  4. Pharyngeal erythema
  5. Gray-white tenacious exudate or "membrane" adheres to posterior pharynx
    1. Occurs at Tonsillar Pillars and posterior pharynx
    2. Leaves focal hemorrhagic raw surface when removed
  6. Cervical Lymphadenopathy

VI. Differential Diagnosis

  1. Vincent's Angina (Trench Mouth)
    1. Also shows pseudomembrane formation
  2. Pharyngitis

VII. Labs

  1. Complete Blood Count (CBC)
    1. Leukocytosis
  2. Throat Culture and nasal culture
    1. Positive for Corynebacterium organisms

VIII. Management

  1. Droplet precautions
  2. Diphtheria antitoxin (Equine serum from CDC)
    1. Scratch test before use
  3. Antibiotics for 14 day duration
    1. Erythromycin 20 mg/kg/day divided every 6 hours IV or
    2. Penicillin G 50,000 units/kg up to 1.2 MU/day IV every 12 hours, then transition to Penicillin VK when able
  4. Culture and Treat contacts
    1. Procaine Penicillin for 1 dose OR
    2. Erythromycin for 7-10 days

IX. Prognosis

  1. Without treatment, Diphtheria has a mortality rate as high as 50%
  2. With treatment, mortality may still approach 5-10%

X. Prevention

  1. DTP Vaccination or DTaP Vaccination

XI. Resources

  1. CDC - Diphtheria
    1. https://www.cdc.gov/diphtheria/clinicians.html

XII. References

  1. Sanford Guide, accessed on IOS 12/29/2019

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